Specific therapeutic exercise of the neck induces immediate local hypoalgesia.

O'Leary S, Falla D, Hodges PW, Jull G, Vicenzino B

This study compared the effect of 2 specific cervical flexor muscle exercise protocols on immediate pain relief in the cervical spine of people with chronic neck pain. In addition, the study evaluated whether these exercise protocols elicited any systemic effects by studying sympathetic nervous system (SNS) function and pain at a location distant from the cervical spine. Participants were randomly allocated into either a cranio-cervical flexion (CCF) coordination exercise group or a cervical flexion (CF) endurance exercise group. Measures of pain and SNS function were recorded immediately before and after a single session of the exercise interventions.  Immediately after 1 session of exercise, there was a reasonably sized increase in pressure pain threshold locally at the neck for the CCF exercise and the CF exercise. There were no changes in local neck thermal pain threshold with either exercise. Pressure pain threshold and  thermal pain threshold at the leg and SNS did not change after exercise. Only the CCF exercise demonstrated a small improvement in VAS ratings during active movement.

This study shows that specific CCF therapeutic exercise is likely to provide immediate change in mechanical hyperalgesia local to the neck with translation into perceived pain relief on movement in patients with chronic neck pain. Understanding the pain-relieving effects of exercise will assist the clinician in prescribing the most appropriate exercise protocols for patients with chronic neck pain.

Journal of Pain, 2007, 8(11), 832-9

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